P-2010-01079 INITIAL REQUEST

• Document Type: FOIA
• Collection: FOIA Collection
• Document Number (FOIA) /ESDN (CREST): 05581735
• Release Decision: RIPPUB
• Original Classification: U
• Document Page Count: 4
• Document Creation Date: March 9, 2023
• Document Release Date: December 8, 2021
• Case Number: F-2011-02160
• Publication Date: September 9, 2010

Approved for Release: 2021/12/07 C05581735
Central Intelligence Agency
Washington, D.C.20505
Dear
August 17, 2010
On 4 August 2010 we received your letter dated 28 July 2010 requesting information on
you.
The Privacy Act requires federal agencies to safeguard personally identifiable information
about an individual. CIA's Privacy Regulations, Title 32 C.F.R, � 1901.13, establish the criteria
below:
An individual seeking access to or amendment of records about himself
shall provide in the letter of request his full(legal) name, address, date
and place of birth, and current citizenship status together with a
statement that such information is true under penalty of perjury or a
notarized statement swearing to or affirming his identity. In the case of
an individual who is an alien lawfully admitted for permanent residence,
said individual shall provide his or her alien registration number and the
date that status was acquired.
In order to process your request you must send us a statement with this information. You
must have your statement notarized, or sign it under penalty of perjury (28 U.S.C. � 1746), and
verify that you are a U.S. citizen or a legal permanent resident. If you are a legal permanent
resident (LRR), you must provide your LPR number and the date that status was acquired. If you
have become a U.S. citizen, you must provide your naturalization number and the date that status
was acquired.
Because you not provided the information we requi ve�are closing�your request at
this time, Once we receive the necessary information, we can then begin processing your request.
Sincerely,
Delores M. Nelson
Information and Privacy Coordinator
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U.S. Department of Justice
Certification of Identity
atteettpx"nel
Is
Privacy Act Statement. In accordance with 28 CFR Section 16.41(d) personal data sufficient to identify the individuals submitting requests
by mail under the Privacy Act of 1974, 5 U.S.C. Section 552a, is required. The purpose of this solicitation is to ensure that the records of
individuals who are the subject of U.S. Department of Justice systems of records are not wrongfidly disclosed by the Department Failure to
furnish this information will result in no action being taken on the request False information on this form may subject the requester to crim-
inal penalties under 18 U.S.C. Section 1001 and/or 5 U.S.C. Section 552a(i)(3).
Public reporting burden for this collection of information is estimated to average 0.50 hours per response, including the time for review-
ing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection
of information. Suggestions for reducing this burden may be submitted to Director, Facilities and Administrative Services staff, Justice
Management Division, U.S. Department of Justice, Washington, DC 20530 and the Office of Information and Regulatory Affairs, Office
of Management and Budget, Public Use Reports Project (1103-0016), Washington, DC 20503,
Full Name of Requester
Citizenship Sta
Current Address
Date of Birth
2
Social Security Num
Place of Birth
(b)(6)
(b)(6)
'(b)(6)
(b)(6)
I declare under penalty of perjury under the laws of the United States of America that the foregoing is true and correct, and that lam the
person named above, and I understand that any falsification of this statement is punishable under the provisions of 18 U.S.C. Section 1001
by a fine of not more than $10,000 or by imprisonment of not more than five years or both, and that requesting or obtaining any record(s)
under false p-e encec it rotnichahle tinder thp nrnvkinnc nf 5 id sr 559s(lf hv n -fine ef not more than $5,000.
Date S-73 0
Signature
0 LIONA._
This form is also to be completed by a requester who is authorizing information relating to himself or herself to be released to another person.
Further, pursuant to 5 U.S.C. Section 552a(b), I authorize the U.S. Department of Justice to release any and all information relating to me to:
4lo`
or iype 1N striae
I Name of individual who is the subject of the record sought.
??4
ELI WAS JR
(b)(6)
(b)(6)
Notary Public - Slate of Florida 41
My Comm, Expires Mar 26, 2013 )
Commission it CD 874893
WS'
2 Individual submitting a request under the Privacy Act of 1974 must be either "a citizen of the United States or an Alien lawfully
admitted for permanent residence," pursuant to 5 U.S.C. Section 552a(a)(2). Requests will be processed as Freedom of Information Act
requests pursuant to 5 U.S.C. Section 552, rather than Privacy Act requests, for individuals who are not United States citizens or aliens
lawfully admitted for permanent residence.
3 Providing your social security number is voluntary. You are asked to provide your social security number only to facilitate the
identification of records relating to you. Without your social security number, the Department may be unable to locate any or all records
pertaining to you.
'Signature of individual who is the subject of the record sought.
FORM APPROVED OMB NO. 1103-0016
EXPIRES 10/31/10
FORM D07-361
APR.01
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FOIA/PA Mail Referral Unit
Department of Justice
Room 115-LOC Building
Washington, DE 20530-0001
[phone]/
[phone] fax
To Whom It May Concern:
July 28, 2010
Freedom of 'Information Act (FOIA) REQUEST
I am writing to request and inspect my files on any and all investigations and surveillance since I
wrote previously in 1996 and beyond. In making this FOIA request pursuant to 47 C.ER. � 0.461, ANt
5 U.S.C, 5 552, please let me know your findings as to past investigations and/or present or on going
Under the Freedom of Information Act, 5 U.S.C. subsection 552, I am requesting info
o
(
I am willing to pay the appropriate fees for a full record under my name that the
FBI has obtained and any other agency collecting data and electronic censorships, NSA, DOD, and DOE
etc. to include DOJ complaints filed over the years if possible, and at the local levels of law enforcement
If there are any fees for searching for, reviewing, or copying the records, please let me know before you
task my request.
If you deny all or any part of this request, please cite each specific exemption you think justifies your
refusal to release the information and notify me of appeal procedures available under the law,
I would also like to obtain the guidelines of invesi,.tions to the public done privately or covertly.
If you have any questions about handling this request, you may telephone me at the above number
provided.
Sin rr-rg�Ivr
(b)(6)
(b)(6)
(b)(6)
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(b)(6)
(b)(6)
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